Understanding chronic (persistent) pelvic pain

Any injury or condition that causes pain for more than three months, and impacts on your quality of life, will be classed as chronic or persistent pain. We have a page with information about ‘Acute or chronic pain?’ which may help you to identify which type of pain you are currently experiencing.

How we feel pain

Our brain and nervous system are responsible for how we feel pain, regardless of the cause. The longer we experience pain in one or more areas of our body, the more our nervous system can become over-sensitised. We need to re-educate this system to reduce and manage our pain in the same way we need to re-educate and exercise our muscles following injury or for conditions such as PGP. This re-education process often involves addressing the elements of the pain cycle (see below) that affect you.

Treating chronic pain associated with PGP

Many women find that their pain improves as they start to receive effective manual therapy treatment from an experienced manual therapist. Others find that their symptoms are irritable and so they may need to actively treat their pain first to get it under control before feeling able to continue with hands-on treatment. In some cases, women continue to feel pain even though their pelvic joints and their muscles are working normally. This is most likely to be due to the nervous system being over-sensitised because the pain has been going on for some time. It is important to access the right care to work on all elements of the pain cycle for the best outcome (see information below).

If you are struggling to cope with manual therapy treatment of your pelvic joints and muscles due to pain and fatigue then you may need pain medication or alternatives to medication such as acupuncture to help you cope with this hands-on treatment. Please see our ‘Pain in PGP’ section for pain treatments you could explore with your GP.

Understanding the chronic pain cycle

The chronic pain cycle describes how mind and body work together to cause chronic pain. Look at the diagram below to help you identify which elements you need to address. We are all different so you may identify with one or two elements or you may identify with all of the elements of the pain cycle.

Decrease in physical strength (muscular de-conditioning) and fatigue: when you develop a chronic pain problem caused by joints, muscles or other tissues in your body (which is the case with PGP) your strength can easily decrease and you can experience fatigue (feel tired) quicker than usual when carrying out normal day-to-day activities. This leads to an increase in pain caused by muscles working incorrectly, becoming shorter and tighter, or going into spasm, which means you are likely to start avoiding activities and exercise that make your pain worse.

This cycle continues until your pain and the underlying cause of your pain are treated and you are able to reintroduce day-to-day activities and exercise that you may have been avoiding. Once your pelvic joints have been treated by a manual therapist, your pelvis is functioning normally and your pain is being managed well, you will be encouraged to gradually introduce exercise to regain strength in the muscles supporting your pelvis. The rate at which you will be able to increase this exercise may depend on the length of time you have been experiencing your pain and how de-conditioned your muscles have become. You will probably need to pace your daily activities to enable you to participate in this rehabilitation process as you may fatigue quite quickly.

Emotional problems including anxiety and depression: anyone experiencing chronic pain may also be experiencing emotional symptoms, including anxiety (fear of pain and the future with pain) and depression (low mood and lack of motivation). These symptoms can have a huge impact on the rate at which you recover from or learn to manage your pain. It is important to talk about how you are feeling and seek the right support. Anxiety can also cause you to hold your muscles in a certain way, stopping them from functioning correctly; recognising this relationship between anxiety and stress and your muscles can help you to break this pattern. Addressing these symptoms can enable you to engage in and cope with addressing other elements of the pain cycle that are affecting you and the ‘hands-on’ treatment for PGP. Please see the ‘Emotional impact of PGP’ section of our website for ideas about how to treat these symptoms.

Personal relationships: chronic pain can have an impact on how you cope with day-to-day activities at home or at work but also on personal relationships with your partner, family members or friends. Many women have reported that they feel a loss of independence, isolated and alone due to their physical and emotional symptoms of PGP. It can be difficult to ask for help and express how you feel but it is important to do this to help yourself and your relationships. Often partners, family members and friends feel relieved when you share how you are feeling and feel more informed and empowered to help you. Please see our ‘You and your relationships’ page for more information.

Weight management: if you are overweight this puts additional stress on your joints and muscles, which in the case of PGP are already stressed from working incorrectly. It can be very hard to lose weight when you are injured or experiencing conditions such as PGP as you are often unable to exercise easily, but it can help to think about what you are eating, keeping sweet/sugary foods and savoury snacks for treats rather than eating them every day. Small changes can often make a big difference. You may be experiencing a decrease in appetite due to pain. Skipping meals or being underweight can contribute to fatigue, so maintaining a healthy balanced diet is an important factor in the management of chronic pain.

The treatment of chronic pain can be complex and require considerable input and support from a number of health professionals (including doctors, psychologists, counsellors, physiotherapists and occupational therapists). This treatment can include medication, physiotherapy, acupuncture, counselling, cognitive behavioural therapy (CBT), relaxation techniques and more. Treatment for chronic pelvic pain is often best arranged through specialised pain services such as pain clinics and pain management programmes, to which your GP can refer you. The Pelvic Pain Network holds a list of pain clinics in the UK.

Further information about the treatment and management of chronic pain

You may find it helpful to visit the ‘Practical suggestions’ section of our website which has tips and information on equipment that can be useful to help you manage at home and when out and about whilst engaging in treatment for your pain and pelvic joints.

This five-minute YouTube video is helpful in explaining about chronic/persistent pain:

The Pelvic Partnership consists of volunteers who have had Pelvic Girdle Pain (PGP) and wish to support other women. We aim to pass on information based on both research and the experience of other women with PGP. We are not medical professionals and cannot offer medical advice and the information we provide should not take the place of advice and guidance from your own health-care providers. Material on this site is provided for information and support purposes only.